Cervical cancer prevention in Australia: an evolving process towards elimination

Australia established a National Cervical Screening Programme (NCSP) in 1991 using the Papanicolaou smear on a 2-yearly interval. This led to an initial drop in cervical cancer incidence, mainly of the squamous origin, but has plateaued since 2007. Introduction of a National HPV Vaccination Program for girls in 2007, which now includes boys, was followed by a major change in the NCSP to a 5-yearly cervical screening for people aged 25–74, using a primary human papillomavirus (HPV) test with partial HPV genotyping and reflex liquid-based cytology triage, designated as a Cervical Screening Test. The next important milestone was expanding the option of self-collection to all eligible people in 2022 to encourage more participation in cervical screening. Population-based cancer screening programmes require monitoring of their performance, quality and safety. NCSP monitoring reports are produced annually with performance indicators grouped under each of the five population screening pathway stages of ‘Recruitment’, ‘Screening’, ‘Assessment’, ‘Diagnosis’ and ‘Outcomes’. From this monitoring, changes are being made in the renewed NCSP Guidelines to improve participation and management of screened abnormalities. All this is underpinned by the provision of cervical screening data by the National Cancer Screening Register. In 2020, WHO published the Global Strategy for cervical cancer elimination with goals to achieve through HPV vaccination, screening with a high-performance test and women identified with cervical disease receiving treatment. Australia has made good progress in 2023 with 84.2% HPV vaccine coverage for girls by the age of 15 years, 82.8% of women aged 35–39 screened at least once with an HPV test and 79.8% of women aged 45–49 having been screened at least twice, and 84.5% and 88.7% of those with precancer detected in 2022 were treated within 6 and 12 months.